Provider Demographics
NPI:1871663997
Name:KEMP, EDNA FAYE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:FAYE
Last Name:KEMP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5660 CAITO DR
Mailing Address - Street 2:BLDG 3 SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1372
Mailing Address - Country:US
Mailing Address - Phone:317-545-5367
Mailing Address - Fax:317-545-6230
Practice Address - Street 1:5660 CAITO DR
Practice Address - Street 2:BLDG 3 SUITE 130
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1372
Practice Address - Country:US
Practice Address - Phone:317-545-5367
Practice Address - Fax:317-545-6230
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120093581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100118850Medicaid